20061233 Ver 1_Certification of Completion_20090904

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen ft. Sullins
Governor Director
DWQ Project No.: Zoo(o - 1233 County: E
Applicant: // ,D e L ,4.N,() Hitt C-
ProjectName: Pus5psi--- GP-K. E6363QI. 29-L/&, S, 5 A.ORW-1
Date of Issuance of 401 Water Quality Certification: A f a. 3 Zoo b
Dee Freeman
Secretary
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be returned to DWQ
by the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from
all of these.
Applicant's Certificatiq
/m c- , hereby state that, to the best of my abilities, due care and diligence
was used in the obse at on of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials.
Signature: w ?d?o Qpt?, Date: 9- 3- o q
A=t's er tificatio
/no-, hereby state that, to
was used in the observa ton of the construction such that the construe
compliance and intent of the 401 Water Quality Certification and Bu
and other supporting materials.
Signature: Date: ej - 3- 0 9
the best of my abilities, due care and diligence
tion was observed to be built within substantial
ffer Rules, the approved plans and specifications,
If thin project was designed hy,,a Certified Professional
I, (J?c wox? '101. l d vu,-.p--as a duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to observe (periodically,
weekly, full time) the construction of the project, for the Permitee hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications and other supporting materials. i
Signature Registration
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0
Date
WETLANDS AND STER W.kTEl?TER QUALITy
North Carolina Division of Water Quality !!
RANCH
943 Washington Square Mall
Washington, NC 27889 one
Phone: [phone] FAX: [phone] North C arol i n a
Internet: www.ncwaterquality.orq ?aturallt?
An Equal Opportunity 1 Affirmative Action Employer